Elbow Conditions Flashcards
(21 cards)
Describe OCD of the elbow
- disorder of cartilage+subchondral bone - leads to fragmentation+necrosis
- more common in capitellum
- more common in teens/overhead/throwing sports
- d/t compression on lateral side - radial impaction on capitellum
- can lead to arthritis quickly so important to pick up quickly
What are the MRI Staging of OCD - and which stages are suitable for conservative vs surgical management?
Stage 1 - thickened articular cartilage; low signal changes (stable)
Stage 2 - articlar cartilage breached; low signal rim beyond fragment indicating fibrous attachment (Stable)
Stage 3 - articlar cartilage breached; HIGH signal changes behind fragment and underlying subchondral bone (unstable)
Stage 4 - Loose body (unstable)
What is the clinical presentation of OCD? Physical exam findings?
- repetitive activity (throwing)
- catching, clicking, locking
- joint pain/stiffness
PE findings:
- effusion
- reduced AROM/PROM
- TTP over radiocapitellum joint
- crepitus
Management of OCD
- refer as this needs specialist consult
Describe the aetiology of lateral epicondylitis
Occurs 1-2 cm distal to lat epicondyle; Repetitive extension+sup/pron > CEO overuse > microtears > collagen degradation > angiofibroblastic proliferation
Healing lags behind microtrauma
What are the risk factors for LE?
Excess load
- poor technique
- overuse
- heavy racquet/small grip
Mm imbalance between flexors/extensors
Inflexibility
Playing a racquet sport (increase risk by 2.8)
Poor blood supply - causes degenerative changes in rendon
Clincal features of LE
- localized pain but may extend into forearm
- 1-2 cm distal to lateral epicondyle
- pain is worse with gripping but if very irritable can be painful even with picking up light objects (eg coffee cup)
Physical exam for LE
TTP over lateral epicondyle
IMT of wrist/finger extensors
Imaging rarely needed
Treatment of LE
First line care
Rest/activity modification, NSAIDs might be helpful (insufficient evidence - Green 2002), Compression straps, Taping (diamond taping)
Manual therapy - may improve px/grip strength but long term effects unclear
Acupuncture - no benefit shown
ESWT - no benefit shown
Steroid injection - short term benefit but poorer long term outcome- not recommended
What is the rationale and plan for eccentric ex in LE?
Rationale:
- same as for eccentric ex in general
- increased collagen production+alignment; improving tendon strength+cross linkage
Stretch with 15-30s holds; 3x10reps; cryotherapy; slow, medium, fast speeds
What is the general management plan for pts with LE pain?
If PRTEE <54, pain duration < 3months, no adverse prognostic indicators, then:
- advice, work station changes, self management, load management
If no change in 6-12 weeks, then:
- add exercise in week 8
- add MWMs
If not improved in 6-8 weeks
- add modalities (laser/taping/ESWT
If not improved in 8-12 weeks
- consider other dx’s
- pain education
- referral/meds
What are adverse prognostic indicators for LE?
- high pain
- high disability
- PRTEE > 54
- repetitive manual work
- coexisting neck+arm pain
- cold hyperalgesia
What is the aetiology of UCL?
- tear/laxity of UCL
- ACUTE injury d/t valgus force (Eg. fall, tackle)
- REPETITIVE use injury from valgus stress
What are the physical exam findings in UCL injury?
- medial sided pain/TTP over UCL
- swelling/bruising in acute injury
- pain/laxity with valgus test
- may also have golfers elbow as flexors act as 2º stabilisers resisting valgus strain
Management of UCL
- rest/bracing
- ROM
- strengthen elbow flexors/pronators
- progressive RTS
- technique/workload
Prognosis for UCL
- 40% return to throwing in 6 months
- surgical correction needed if there’s continued instability/symptomsm
Describe olecranon bursitis
Inflammation of the superficial or subcutaneous bursa
- might be acute/chronic/septic/aseptic
Presentation of olecranon bursitis
- trauma/repetitive pressure on elbow
- SWELLING is main complaint - often enough to make dx
- AROM flexion can be limited
- TTP directly
Treatment of bursitis
Rest/ice/compression/activity mod
- persistent case = aspiration/corticosteroid injection/surgical excision
What causes elbow instability and what are the 2 types?
- caused by dislocation or initial ligamentous injury
2 types:
- valgus instability (UCL strain)
- posterolateral instability (after dislocation)
What is the presentation of elbow instability?
- subluxation, catching, locking
- pain when pushing up from seated position
